Multiple Clinical Manifestations of Lichenoid Spectrum: A Patient with Frontal Fibrosing Alopecia, Lichen Planus Pigmentosus, and Nail Lichen Planus

Abstract

<b><i>Introduction:</i></b> Frontal fibrosing alopecia (FFA) is characterized by irreversible, symmetrical band-like hair loss in the frontotemporal region. Lichen planus pigmentosus (LPP) is a variant of lichen planus (LP) that presents with hyperpigmented macules and patches predominantly in sun-exposed areas. Nail LP is a subtype of LP that can be present alone or with other forms of LP. <b><i>Case Report:</i></b> We report a rare case of a 59-year-old woman presenting with symmetrical, gray-brown, hyperpigmented lesions on her neck and face, band-like alopecia in the frontotemporal region, severe onycholysis in two fingernails, and prominent longitudinal ridging in all fingernails. Clinical, dermoscopic, and histological findings established a diagnosis of FFA associated with LPP and nail LP was established. <b><i>Discussion/Conclusion:</i></b> In recent years, it has been established that FFA can be associated with LPP and it is thought to be a variant of lichen planopilaris. Nail involvement is rarely reported in FFA or LPP. To our knowledge, the presence of the three conditions in the same patient has not been previously reported. Although rare we would like to emphasize the importance of a careful examination of the nails in patients with FFA and/or LPP to prevent irreversible nail changes.

Lichen Planus Pigmentosus Inversus: A Case Report of a Man Presenting With a Pigmented Lichenoid Axillary Inverse Dermatosis (PLAID)

“…The distribution of the skin darkening may be related to the etiology of the condition. The affected body locations can range from being diffuse, or areas that are sun-exposed, or less commonly restricted to intertriginous sites [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20].…”

“…Occasionally, dyschromia is restricted to the axilla. When the axillary hyperpigmentation is the result of a lichenoid lymphocytic inflammatory process that is presenting in a distribution that is inverse and opposite to the body areas typically affected by the condition, it can be referred to as a pigmented lichenoid axillary inverse dermatosis or PLAID [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20].…”

“…Lichen planus often appears in flexural areas; however, when intertriginous sites predominate, the condition is designated as the less common subtype of inverse lichen planus. Lichen planus pigmentosus is an infrequent variant of lichen planus that is typically localized to sun-exposed areas; rarely, this subtype of lichen planus concurrently or only involves intertriginous locations and is described as lichen planus pigmentosus inversus [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20].…”

“…Lichen planus pigmentosus is an uncommon subtype of lichen planus; albeit less commonly, classical lichen planus lesions have been observed in patients with lichen planus pigmentosus [3][4][5][6][7][8][9]. Lichen planus pigmentosus usually appears on sun-exposed body sites [3,4,[7][8][9][10].…”

“…External mechanical irritation from friction or tightly fitting underclothes may predispose to the development of lichen planus pigmentosus inversus. The dyschromia resulting from lichen planus pigmentosus inversus can be an issue of cosmetic concern for affected individuals; however, in contrast to inverse lichen planus, the typically asymptomatic hyperpigmentation of lichen planus pigmentosus inversus is often refractory to therapeutic interventions [3][4][5][6][7][8][9][11][12][13][14][15][16][17][18][19][20].…”